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Cost-effectiveness of stepwise provisional versus systematic dual stenting strategies in patients with distal bifurcation left main stem lesions: Economic analysis of the EBC MAIN trial

Lookup NU author(s): Dr Mohaned Egred

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

Abstract

© 2024 BMJ Publishing Group. All rights reserved.Background In patients with distal bifurcation left main stem lesions requiring intervention, the European Bifurcation Club Left Main Coronary Stent Study trial found a non-significant difference in major adverse cardiac events (MACEs, composite of all-cause death, non-fatal myocardial infarction and target lesion revascularisation) favouring the stepwise provisional strategy, compared with the systematic dual stenting. Aims To estimate the 1-year cost-effectiveness of stepwise provisional versus systematic dual stenting strategies. Methods Costs in France and the UK, and MACE were calculated in both groups to estimate the incremental cost-effectiveness ratio (ICER). Uncertainty was explored by probabilistic bootstrapping. The analysis was conducted from the perspective of the healthcare provider with a time horizon of 1 year. Results The cost difference between the two groups was €-755 (€5700 in the stepwise provisional group and €6455 in the systematic dual stenting group, p value<0.01) in France and €-647 (€6728 and €7375, respectively, p value=0.08) in the UK. The point estimates for the ICERs found that stepwise provisional strategy was cost saving and improved outcomes with a probabilistic sensitivity analysis confirming dominance with an 80% probability. Conclusion The stepwise provisional strategy at 1 year is dominant compared with the systematic dual stenting strategy on both economic and clinical outcomes.

Publication metadata

Author(s): Le Bras A, Hildick-Smith D, Nze Ossima A, Supplisson O, Egred M, Brunel P, Banning AP, Morice M-C, Durand-Zaleski I

Publication type: Article

Publication status: Published

Journal: Open Heart

Year: 2024

Volume: 11

Issue: 1

Print publication date: 01/02/2024

Online publication date: 19/01/2024

Acceptance date: 13/12/2023

Date deposited: 06/02/2024

ISSN (print): 2398-595X

ISSN (electronic): 2053-3624

Publisher: BMJ Publishing Group

URL: https://doi.org/10.1136/openhrt-2023-002479

DOI: 10.1136/openhrt-2023-002479

Data Access Statement: Data are available upon reasonable request.

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